Influence of incisor inclination and anterior vertical facial height on facial attractiveness in an adult Asian male.

INTRODUCTION: Balanced facial proportions and hard tissue relationships are important factors in facial attractiveness. The objective of this study was to determine the most pleasing maxillary incisal inclination (MII) on the lateral profile and the impact of various lower anterior facial height (LAFH) ratios (at rest and with a smile) on facial attractiveness. METHODS: This cross-sectional study was performed with 66 raters equally divided into 3 panels: general dentists (GD), orthodontic residents (OR), and laypersons (LP). Lateral profile view photographs of an Asian man were modified using Photoshop software (Adobe Systems, San Jose, Calif) to show altered MII and LAFH ratios at rest and when smiling. Subjective evaluations of facial attractiveness were performed by raters using a visual analog scale. Kruskal-Wallis test was used to compare esthetic scores among raters, and the Mann-Whitney U test was applied to compare ES between groups. RESULTS: Kruskal-Wallis test showed significant differences in esthetic scores among raters for -10° (P = 0.028) and -15° MII (P = 0.030). Similarly, significant differences were found in ES for 8% LAFH ratio (P = 0.022), and 4% LAFH ratio (P = 0.035) at rest. Mann-Whitney U test showed significant differences between raters for -10° and -15° MII and between 8% and 4% LAFH ratio at rest. CONCLUSIONS: All groups rated -5° inclinations to be most attractive. General dentists and orthodontic residents found normal LAFH to be the most attractive, whereas long facial height was less attractive with smile. In addition, smile had a camouflaging effect on LAFH.

The influence of incisor inclination and anterior vertical facial height on facial attractiveness in an Asian woman.

INTRODUCTION: Orthodontic treatment can help improve facial attractiveness through the modification of factors affecting the soft tissue profile. The objectives of this study were to determine the impact of different maxillary incisal inclinations and lower anterior facial heights (at rest and with a smile) on the facial attractiveness of an Asian woman, as perceived by different panels of raters using visual analog scale (VAS) scores. METHODS: A cross-sectional study was performed with 66 raters equally divided into 3 panels that consisted of general dentists, orthodontic residents, and laypersons. Raters assessed modified photographs of a subject with various incisor inclinations and lower anterior facial height/total anterior facial height (LAFH/TAFH) on lateral profile view. Modifications were made using Photoshop software (Adobe, San Jose, Calif). Subjective evaluations of facial attractiveness were performed by raters using VAS. Kruskal-Wallis test was used to compare VAS scores among raters. Mann-Whitney U test was applied to compare VAS scores between groups. RESULTS: Significant differences in VAS scores were found among raters for -10° (P = 0.004) and -15° (P = 0.021) incisal inclinations. Significant differences were found in VAS scores for -8% LAFH/TAFH (P = 0.044) and 4% LAFH/TAFH with smile (P = 0.002). CONCLUSIONS: Professionals preferred normal incisal inclinations to be the most attractive. General dentists found reduced facial height to be unattractive. Orthodontic residents and laypersons considered increased LAFH/TAFH to be most unattractive. Smile had a negative impact on VAS scores at extreme anterior facial height modifications.

Evaluation of cervical spine posture after functional therapy with twin-block appliances: A retrospective cohort study.

INTRODUCTION: It has been postulated that a change in cervical posture occurs as a consequence of forward repositioning of the mandible. Therefore, the objective of this study was to compare the cervical spine posture between subjects with and without functional appliance therapy. METHODS: A retrospective cohort study was conducted with the use of pre- and post-functional therapy cephalograms of orthodontic patients. A total of 60 subjects was composed of 2 groups of 30 subjects each: those who underwent treatment with a twin-block (TB) functional appliance and a control group selected from the Bolton-Brush Growth Study. Three sagittal and 7 cervical vertebral parameters were compared between the groups. The Wilcoxon signed-rank test was used to compare pre- and postfunctional mean angular measurements. The Mann-Whitney U test was used to compare the mean changes in cervical parameters between the groups. RESULTS: A significant difference existed between pre- and postfunctional SNB (P <0.001) and ANB (P <0.001) angles, showing a change in maxillomandibular relationship. Comparison of mean changes in angular measurements between the 2 groups showed a significant difference (P = 0.032) in the sella-nasion to odontoid process tangent (SN-OPT) angle. The SN-OPT angle predicted that the probability of developing an altered cervical posture with the TB appliance is 2.08 times greater than without the TB appliance. CONCLUSIONS: SN-OPT angle can predict a change in skeletal relationships after treatment with the TB functional appliance. The TB causes the craniocervical posture to be more upright. Subjects with reduced vertical dimensions have greater change in cervical posture.

Adjunctive surgical procedures enhancing treatment outcome - A literature review.

The face is the most expressive zone of the human body that communicates our feelings and thoughts. This may also influence the interaction between people. The aesthetic adjunctive procedures are life-changing. In contemporary orthodontic treatment, orthognathic surgeries are performed to correct the functional aspects of dento facial deformities. In cases where the aesthetic outcome is not improved, patient dissatisfaction is often encountered. Many adjunctive surgical procedures can be used to enhance the anaesthetics of orthodontic or orthognathic surgical cases. Dwelling not merely on the ideal occlusion, the results could be enhanced by analysing the whole-face to improve the overall treatment outcome.

Improvement in Peer Assessment Rating scores after nonextraction, premolar extraction, and mandibular incisor extraction treatments in patients with Class I malocclusion.

INTRODUCTION: Different treatment protocols implemented for correction of Class I malocclusion aim at achieving ideal occlusal characteristics. This study was planned to evaluate the improvement in the occlusal characteristics of Class I patients treated with nonextraction (NE), all first premolar extractions (PME), and mandibular incisor extraction (MIE) as assessed by the percentage of improvement in Peer Assessment Rating (PAR) scores. METHODS: This retrospective cross-sectional study was conducted on the pretreatment and posttreatment dental casts of 108 subjects with Class I malocclusion. The total sample was divided into 3 equal groups according to the treatment protocol implemented: NE, PME, and MIE. The mean pretreatment and posttreatment PAR scores, and the percentages of improvement were compared among the 3 treatment modalities using Kruskal-Wallis and post-hoc Dunnett T3 tests. RESULTS: The mean percentages of improvement in the PAR score were 75.8% ± 25.8% in the NE group, 73.1% ± 19.4% in the PME group, and 70.6% ± 24.1% in the MIE group. There was no significant difference (P = 0.351) in the percentages of improvement in PAR scores among the 3 treatment modalities. However, the mean pretreatment and posttreatment PAR scores varied significantly (P <0.001) in the 3 groups. The average pretreatment and posttreatment PAR scores were highest in the MIE group and lowest in the NE group. CONCLUSIONS: The comparable percentages of improvement in PAR scores among the 3 groups denote that equivalent occlusal corrections were achieved in Class I patients treated with the NE, PME, and MIE protocols.

Occlusal Outcome Of Non-Extraction And All First Premolars Extraction Treatment In Patients With Class-I Malocclusion.

BACKGROUND: Class-1 malocclusion commonly presents with crowding and poses an aesthetic concern to patients. An orthodontist may encounter a variety of dental problems and must handle them strategically to establish adequate occlusal relationships. Hence, this study was conducted to evaluate the occlusal characteristics of patients who have undergone non-extraction or all first premolars extraction treatment for class I malocclusion using the peer assessment rating (PAR) index. METHODS: The pre-treatment and post treatment dental casts of 94 subjects with class-I malocclusion were retrospectively screened. The sample was distributed into two groups, i.e., nonextraction and all first premolars extraction groups. The Mann Whitney-U test was used to compare the mean percentage improvement in the PAR scores between the two groups. A p-value of ≤0.05 was considered statistically significant. RESULTS: The mean percentage improvement in the non-extraction group was 74.28% in the non-extraction group and 74.5% in the all first premolars extraction group. A significant difference (p=0.04) was found between the pretreatment PAR scores for the two treatment modalities. There was no significant difference between the post treatment PAR scores (p=0.45) and the mean percentage improvement in PAR scores (p=0.41) between the treatment groups. CONCLUSIONS: The improvement in occlusal characteristics in patients who underwent non-extraction treatment and all first premolar extraction treatment was comparable as assessed through mean percentage improvement in PAR scores.

Stress and anxiety among dental practitioners during the COVID-19 pandemic: A cross-sectional survey.

BACKGROUND: Dental professionals are at great risk of contracting coronavirus disease 2019 (COVID-19). OBJECTIVES: The objectives of this study were to determine the levels of stress and anxiety among dental professionals, and to determine which dental procedures cause the greatest amount of stress and anxiety during the COVID-19 pandemic. MATERIAL AND METHODS: This cross-sectional survey was conducted by requesting voluntary participation of dental healthcare workers through the authors' own e-form, which consisted of our self-developed questionnaire, the Perceived Stress Scale (PSS) and the Generalized Anxiety Disorder-7 scale (GAD-7). The simple and multiple linear regression analyses were used to assess the effect of dental procedures and other factors associated with stress and anxiety among the participants. A p-value ≤0.05 was considered statistically significant. RESULTS: This survey included 85 participants (32 males, 53 females) with a mean age of 31.6 ±6.0 years. Significant associations were found between severe stress for scaling (p < 0.001; p < 0.001), complex fillings (p < 0.001; p < 0.001), root canal treatment (RCT) (p = 0.001; p = 0.007), crown and bridge work (p < 0.001; p < 0.001), denture work (p = 0.034; p = 0.001), third molar extractions (p < 0.001; p < 0.001), surgical procedures (p < 0.001; p = 0.001), and implant placement (p = 0.001; p = 0.022) and the PSS and GAD-7 scores, respectively. CONCLUSIONS: Dental healthcare workers exhibit severe stress and anxiety associated with elective dental procedures. Dental emergencies should take precedence and elective dental treatment should be carried out with utmost caution, ensuring all protective measures. Psychological support for dental healthcare professionals should be made accessible.

Dental Characteristics Of Patients Suffering From Temporomandibular Disorders.

BACKGROUND: The role of malocclusion in the aetiology of TMDs has been discussed extensively in literature, however, the varied results from different studies have made it difficult to reach a consensus. The objective of this study was to determine the association of dental characteristics and temporomandibular disorders (TMDs). METHODS: This case-control study involved a total of 266 patients who were equally divided into 2 groups (TMD/Non-TMD) based on the score obtained from the Fonseca's questionnaire. Dental characteristics such as class of malocclusion, overjet, overbite, crossbite, and crowding were assessed. The Chi-square test was used to determine an association between each dental characteristic and TMD. Odds ratios were calculated using simple and multiple logistic regression. RESULTS: Significant associations were found between crowding, crossbites, and molar relationships in males. Simple logistic regression showed significant associations for class II malocclusion (OR=0.56, p=0.024) and crowding (OR=0.35, p<0.001) with TMD. Multiple logistic regression showed significant associations for crowding (p<0.001) and class III malocclusion (p=0.002). CONCLUSIONS: Male patients with dental characteristics such as improper molar relationships, crossbites, and crowding should seek orthodontic treatment to prevent the onset of TMDs. Higher odds of TMD were found in patients with Angle's class III malocclusion.

Does periodontally accelerated osteogenic orthodontics improve orthodontic treatment outcome? A systematic review and meta-analysis.

BACKGROUND: Periodontally accelerated osteogenic orthodontics (PAOO) can be used to improve periodontal conditions and accelerate tooth movement. OBJECTIVE: The aim of this systematic review and meta-analysis was to compare periodontal outcome and treatment duration of patients undergoing PAOO to accelerate orthodontic treatment. SEARCH METHOD: An electronic search was performed in four electronic databases including Pubmed, EBSCO Cochrane library, CINAHL Complete for randomized clinical trials till November 2017. A hand search was performed on clinicaltrials.gov and Google scholar. SELECTION CRITERIA: Randomized controlled trials reporting periodontal outcomes and treatment duration of PAOO in adult patients by evaluating treatment duration, root resorption, bone density and pocket depths were included. DATA COLLECTION AND ANALYSIS: Two authors conducted searches, data extraction and bias assessment with conflict resolution with a third author. Cochrane's tool for risk of bias assessment was used for evaluation. A manual search was conducted for additional studies. A quantitative synthesis of the pooled results was conducted. RESULTS: Five studies were included in the qualitative synthesis and two in the quantitative synthesis. A total of 56 patients underwent the PAOO technique; the effects of this therapy were compared with 21 patients who underwent corticotomy, 9 underwent non-extraction comprehensive orthodontic treatment and 15 underwent fixed mechanotherapy with extractions of first premolars. A random effect model was used for pocket depths and showed a non-significant difference between bioactive glass augmented corticotomy and corticotomy alone (weighted mean difference, -0.03; 95% CI, -0.16, 0.09). Bone density elucidated a non-significant difference between bioactive glass augmented corticotomy and corticotomy alone (weighted mean difference, 27.69; 95% CI, -2.29, 57.67). Fixed effect model was used for root length which revealed a non-significant difference between bioactive glass augmented corticotomy and corticotomy alone (weighted mean difference, 0.01; 95% CI, -0.00, 0.02). CONCLUSIONS: Studies showed significant improvements in periodontal health. Treatment duration was reduced in patients who underwent PAOO. Root resorption was not sufficiently evaluated by current literature.

Application of New Biomedical Materials in Orthodontic Appliances.

This review article describes the application and characteristics of certain biomedical materials in orthodontic appliances. The elastic recoil of shape memory polymers, determination of the forces and moments experienced by the brackets and eventually by the tooth, reduction in treatment time by employing self-healing smart brackets and decreased enamel lost during debonding due to usage of biomimetic adhesives such as dihydroxyphenylalanine (DOPA) is discussed. Increased plaque retention and microbial attachment around brackets and teeth is of profound concern and by utilisation of hydrophobic properties of self-cleaning materials, this can be reduced significantly. Implantation of bioresorbable temporary anchorage devices, which resorb once their purpose is accomplished and increasing the concentration of fluoride in the oral environment to counter the deleterious consequences of orthodontic treatment such as white spot lesions and caries, are also discussed briefly.

Assessment of skeletal maturity using the calcification stages of permanent mandibular teeth.

INTRODUCTION: Knowledge of the growth status of patients is essential to formulate and initiate a precise treatment plan. This study aimed at determining the role of calcification of permanent mandibular teeth for the assessment of skeletal maturity. METHODS: A cross-sectional study was conducted using lateral cephalograms and dental panoramic radiographs of 360 patients (ages 7-18 years) equally divided into six groups according to cervical vertebral maturation stages. Skeletal age was determined using Baccetti et al. method and dental age was calculated using Nolla and Demirjian methods. RESULTS: Mean chronological stage at CS5 revealed a significant difference between male and female subjects (p= 0.003), which showed that the latter achieved skeletal maturity one year earlier than the former. A significant difference (p= 0.007) was found for dental age using Nolla's stages at CS3, which showed females demonstrated a dental age of 1.4 years less than males. Mandibular canine showed the highest correlation with Demirjian index (DI) in males (rho = 0.818) and females (rho = 0.833). Mandibular second premolar showed the highest correlation with Nolla's stages in males (rho = 0.654) and females (rho = 0.664). CONCLUSION: Comparisons between sexes revealed that females are skeletally and dentally advanced. The DI indicated stage F and Nolla's stages identified stages 9, 10 to be indicative of CS2-3 for the mandibular canine and stages F and G and 9-10 for CS2-3 for the first premolars, second premolars and second molars, respectively.

Concepts, protocol, variations and current trends in surgery first orthognathic approach: a literature review.

In the current era of expedited orthodontics, among many clinicians, tertiary care hospitals and patients, surgery first orthognathic approach (SFOA) has gained popularity. The advantages of SFOA (face first approach) are the reduced overall treatment duration and the early improvement in facial esthetics. In SFOA, the absence of a presurgical phase allows surgery to be performed first, followed by comprehensive orthodontic treatment to achieve the desired occlusion. The basic concepts of surgery early, surgery last, SFOA and Sendai SFOA technique along with its variations are reviewed in the present article. The recent advancement in SFOA in the context of preoperative preparation, surgical procedures and post-surgical orthodontics with pertinent literature survey are also discussed.

Assessment of skeletal maturity using the calcification stages of permanent mandibular teeth

Abstract Introduction: Knowledge of the growth status of patients is essential to formulate and initiate a precise treatment plan. This study aimed at determining the role of calcification of permanent mandibular teeth for the assessment of skeletal maturity. Methods: A cross-sectional study was conducted using lateral cephalograms and dental panoramic radiographs of 360 patients (ages 7-18 years) equally divided into six groups according to cervical vertebral maturation stages. Skeletal age was determined using Baccetti et al. method and dental age was calculated using Nolla and Demirjian methods. Results: Mean chronological stage at CS5 revealed a significant difference between male and female subjects (p= 0.003), which showed that the latter achieved skeletal maturity one year earlier than the former. A significant difference (p= 0.007) was found for dental age using Nolla's stages at CS3, which showed females demonstrated a dental age of 1.4 years less than males. Mandibular canine showed the highest correlation with Demirjian index (DI) in males (rho = 0.818) and females (rho = 0.833). Mandibular second premolar showed the highest correlation with Nolla's stages in males (rho = 0.654) and females (rho = 0.664). Conclusion: Comparisons between sexes revealed that females are skeletally and dentally advanced. The DI indicated stage F and Nolla's stages identified stages 9, 10 to be indicative of CS2-3 for the mandibular canine and stages F and G and 9-10 for CS2-3 for the first premolars, second premolars and second molars, respectively.

Resumo Introdução: o conhecimento acerca do status de crescimento dos pacientes é essencial para se formular e iniciar um plano de tratamento preciso. Esse estudo teve como meta determinar a correlação entre a calcificação dos dentes inferiores permanentes e a avaliação da maturação esquelética. Métodos: um estudo transversal foi conduzido utilizando-se radiografias laterais e panorâmicas das arcadas de 360 pacientes (idades entre 7 e 18 anos), igualmente divididos em seis grupos, de acordo com os estágios de maturação esquelética das vértebras cervicais. A idade esquelética foi determinada utilizando-se o método de Baccetti, e a idade dentária foi calculada utilizando-se os métodos de Nolla e Demirjian. Resultados: o estágio cronológico médio em CS5 revelou uma diferença significativa entre os indivíduos do sexo masculino e do feminino (p= 0,003), demonstrando que as meninas alcançavam a maturação esquelética um ano antes dos meninos. Encontrou-se uma diferença significativa (p= 0,007) para a idade dentária utilizando-se os estágios de Nolla em CS3, o que revelou que as meninas exibiam uma idade dentária 1,4 anos inferior à dos meninos. Os caninos inferiores demonstraram a maior correlação com o índice de Demirjian (DI) tanto em indivíduos do sexo masculino (rho = 0,818) quanto do feminino (rho = 0,833). Já os segundos pré-molares inferiores revelaram a maior correlação com os estágios de Nolla, tanto em meninos (rho = 0,654) quanto em meninas (rho = 0,664). Conclusão: as comparações entre os sexos revelaram que as mulheres são mais precoces tanto no desenvolvimento dentário quanto no esquelético. O DI indicou o estágio F, e o método de Nolla identificou os estágios 9 e 10 como indicativos de CS2-3, para os caninos inferiores; e os estágios F e G, e 9 e 10 para CS2-3, para os primeiros e segundos pré-molares, e segundos molares, respectivamente.

Concepts, protocol, variations and current trends in surgery first orthognathic approach: a literature review

ABSTRACT In the current era of expedited orthodontics, among many clinicians, tertiary care hospitals and patients, surgery first orthognathic approach (SFOA) has gained popularity. The advantages of SFOA (face first approach) are the reduced overall treatment duration and the early improvement in facial esthetics. In SFOA, the absence of a presurgical phase allows surgery to be performed first, followed by comprehensive orthodontic treatment to achieve the desired occlusion. The basic concepts of surgery early, surgery last, SFOA and Sendai SFOA technique along with its variations are reviewed in the present article. The recent advancement in SFOA in the context of preoperative preparation, surgical procedures and post-surgical orthodontics with pertinent literature survey are also discussed.

RESUMO Na presente era da Ortodontia de resultados acelerados, a cirurgia ortognática com benefício antecipado (COBA) ganhou popularidade entre muitos clínicos, hospitais terciários e pacientes. A vantagem da COBA é a redução da duração total do tratamento, juntamente com a melhora precoce da estética facial. Na COBA, a ausência de uma fase pré-cirúrgica permite que a cirurgia seja realizada antes e, só então, venha o tratamento ortodôntico abrangente para se alcançar a oclusão desejada. Os conceitos básicos de cirurgia primeiro, cirurgia por último, COBA e a técnica COBA de Sendai, bem como suas variações, são aqui revistos. Também são discutidos no presente artigo, junto com a revisão da literatura pertinente, os recentes avanços da COBA no contexto do preparo pré-cirúrgico, dos procedimentos cirúrgicos e da Ortodontia pós-cirúrgica.